Bedsores, pressure ulcers, decubitus ulcers: There are a lot of names used to describe pressure injuries that patients develop while receiving care in a hospital or skilled nursing facility. Since 2016, the accepted term recommended by the National Pressure Ulcer Advisory Panel is “pressure injury.”
Most physicians and nurses who regularly care for patients with a high risk for developing pressure injuries will quickly tell you that the best treatment is to prevent them from developing in the first place.
What causes pressure injuries?
Historically, much of the focus on pressure injury prevention has been on promoting skin integrity and reducing pressure on immobile patients. There is no doubt that this is important, particularly on bony prominences, such as the hip/tailbone areas and heels.
The standard of care requires physicians and nursing staff to assess each patient’s skin integrity and pressure injury risk upon admission. Patients at a high risk require a skin integrity and pressure injury prevention care plan. High-risk patients may have pre-existing conditions like diabetes or vascular problems, might be immobile and confined to bed, or could already have compromised skin integrity. Over the course of the patient’s care, physicians and nurses must perform regular reassessments.
Skin integrity and pressure injury prevention plans include interventions like these:
• Skincare. This includes applying barrier products, promptly cleaning the skin after bowel or bladder incontinence episodes, and properly positioning the patient to avoid pressure injuries.
• Nutrition. A dietitian is often consulted for recommendations on optimizing patient nutrition to address skin integrity issues. The nursing staff must monitor and document the patient’s weight regularly and ensure adequate nutrition, including protein.
• Repositioning and immobilization. For patients who are unable to get out of bed, the nursing staff should have a schedule for turning and repositioning, to relieve pressure. For many patients, a pressure-relieving mattress may be helpful in reducing risk.
Medical devices and pressure injuries
Recent research has shown that over 30% of all hospital-caused pressure injuries are related to medical devices. This is a significant concern because most patients have at least one medical device used in their care—things like feeding tubes, catheters, oxygen facemasks or nasal cannula, and orthopedic devices.
Hospital accrediting authority The Joint Commission has noted that these medical devices are often rigid and increase the pressure on patients’ skin. There have been many cases where the shape of a pressure injury matches the exact shape of a medical device that had been positioned at that location on the patient’s skin. That leaves little doubt as to the cause!
Describing pressure injuries
Physicians and nurses describe pressure injuries using a staging system that has been defined by the National Pressure Ulcer Advisory Panel. There are four stages, with Stage 1 being the least severe pressure injury, going up to Stage 4, which is a full-thickness injury with tissue loss. The Panel also endorses descriptive language for pressure injuries including unstageable pressure injury, deep tissue pressure injury, medical device-related pressure injury, and mucosal membrane pressure injury.
Most pressure injuries are avoidable with proper preventative measures and treatment. If you’ve been seriously injured because of a pressure injury in a Texas hospital or nursing home, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.